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Idaho Gov. Butch Otter gave the keynote remarks at the sixth annual State of the West Symposium on Dec. 1. Steve Castillo

By May Wong

The political sea change set on Election Day brought urgency and greater weight to the economic issues that were spotlighted at the Sixth Annual State of the West Symposium.

Immigration and health care — the main topics anchoring the Dec. 1 event co-sponsored by the Stanford Institute for Economic Policy Research and the Bill Lane Center for the American West — assumed a heightened level of relevance as government officials, industry insiders and academics discussed their research and policy perspectives.

The two issues are top priorities for President-elect Donald Trump, who, during the same week, was in the thick of his search for cabinet members aligned with the central promises of his campaign: to repeal and replace the Affordable Care Act and to significantly increase border enforcement and clamp down on undocumented workers.

The symposium was organized to take stock of issues affecting the economic well-being of the vast region on the sunset side of the Hundredth Meridian.

“You might think we actually knew what we were doing when we picked these two topics, but, like the rest of the world, we had no idea that we would have such dramatic political change,” Bruce Cain, the Spence and Cleone Eccles Family Director of The Bill Lane Center, said during his opening remarks. “But clearly, you can't imagine two topics that are going to affect the West more.”

“Both the health care and immigration changes we are going to see are going to be quite dramatic,” he said.

The U.S. – Mexico border

Bill Lane Center for the American West faculty director Bruce E. Cain moderated the first panel on immigration.Steve Castillo

Cain, who is also the Charles Louis Ducommun Professor in Humanities and Sciences at Stanford, led the panel that discussed the policy environment involving the U.S.-Mexico border. The panel consisted of Felicia Escobar, Special Assistant to the President for Immigration Policy under the Obama Administration; Doris Meissner, senior fellow and director of U.S. immigration policy at the Migration Policy Institute; Giovanni Peri, professor of economics at University of California, Davis; and Todd Schulte, president of FWD.us.

In detailing the immigration flows of recent decades, Peri noted how the influx of immigrants from Mexico had dropped since 2005, surpassed now by a wave of high-skilled workers from China and India. In fact, the tide over the southern border has turned since 2010 — people returning to Mexico have outnumbered those entering the United States.

What’s more, immigrants are benefiting the American economy, both in supplying labor and starting businesses, as well as in creating demand for goods and services, Peri said.

“These are not people on welfare; they are, in large part, people who are working,” he said, adding that immigrants are fulfilling complementary labor market roles, assuming jobs that are different from those of American-born residents.

Any labor market and immigration reforms should take these dynamics into account, he said.

Contrary to the “hyperbole” of some public discussions, Escobar said lawmakers have increased investments in border security over the past decade under the Obama administration. On top of new monitoring resources and extra fencing, the number of border agents increased from 8,600 to 20,000 in the last 10 years.

In addition, unlike the era of large-scale illegal immigration from the 1980s and 1990s, many of those crossing the border in recent years are not evading patrol agents but presenting themselves, seeking asylum from violence in Central America, Escobar said.

“It’s a very different picture now,” she said.

Meissner (video) and Schulte (video) echoed Escobar in calling for expediting the judicial process for political asylum cases and creating “legal pathways” for the millions of undocumented workers who are already deeply embedded in the economy — half of whom have been living in the United States for over a decade.

“Frankly, we are operating within the confines of a broken law,” Escobar said.

Where is the health care system headed?

SIEPR Director Mark Duggan (left) and Leonard Schaeffer from the University of Southern California talk about health care policy in a Trump administrationSteve Castillo

From combatting poor eating habits to cutting the fat out of the health care industry, speakers on the health care panel provided wide-ranging perspectives on past and future challenges facing the health care system.

Mark Duggan, the Trione Director of SIEPR, moderated the panel, which consisted of Leonard Schaeffer, the Judge Robert Maclay Widney Chair and Professor at the University of Southern California and the founding chair and CEO of WellPoint, Inc. (now known as Anthem); Charles Sorenson, president emeritus of Intermountain Healthcare and founding director of the Intermountain Healthcare Leadership Institute; and Saum Sutaria, senior partner at McKinsey & Company.

The panelists advocated for multi-pronged approaches, including improving the overall health of patients, which in turn would lower health care costs; and designing more efficient delivery of services.

Similar to how taboos on smoking and mandates on car seatbelts have helped save lives, a cultural shift toward eating healthier would translate to big impacts on lowering health care costs, Sorenson said.

“We have to make greater social unacceptability for poor lifestyles,” Sorenson said (video). A holistic, team-based medical approach that includes mental health would also lower overall medical costs, he contended.

Given the political challenges of overhauling legislation, Schaeffer predicted (video) that the new Trump administration would more likely see an “amend-and-delay” situation rather than a complete “repeal-and-replace” scenario of the Affordable Care Act. In the meantime, handing states greater control of health care elements, such as insurance exchanges or Medicaid, for which leading Republican lawmakers are advocating — is “probably going to happen,” he said.

Sutaria explained (video) how investment capital in the health care sector has grown dramatically in recent years, but productivity and improved health outcomes haven’t kept pace.

“The industry is growing and creating a huge amount of economic opportunity at the same time that it is costing us a lot of (taxpayers’) money,” Sutaria said.

“We don’t need more money in the health care system,” he continued. “The question mark is how do we use that money to get better returns?”

During the symposium, Gitane De Silva, Alberta’s senior representative to the United States, delivered a keynote emphasizing how Canada and her province have benefitted tremendously from the North American Free Trade Agreement — another policy area that Trump has vowed to overhaul.

And in his dinner keynote, C.L. “Butch” Otter, Governor of Idaho (video), praised the cooperative working relationships within the Western Governors’ Association and said the nation’s federal lawmakers will need to follow suit to get things done.

When asked by an audience member how the nation can trust a reality-TV show host as its president, Otter, a Republican, pointed to Trump’s business successes.

“Our system is blemished with imperfections, but I'm willing to give it a chance,” he said. “As many times I was in opposition to my government, I had still had faith in our system. And if Hillary Clinton had won, I would say the same thing.”

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